Eligibility Senior Representative - WeCARE

Job Description Summary

This is a cross-functional eligibility representative position focusing on all aspects of eligibility from initial benefits investigation to point of sale same day shipping.

The role is ideal for team players with a willingness to learn new skills and develop processes related to cross-training for streamlining the eligibility process to quickly serve the needs of our patients.



* We are looking for a variety of skills across the team, including a mixture of the following skills and/or experience:


* RxHome and CareCentral trained


* Escalation Management


* Clearance New Referral


* Prior Authorization / Re-Authorization


* Rejection Handling


* Same Day
+ This team continuously adapts, and cross-training will be implemented to achieve versatility in meeting business needs.

As a member of this team, you'll collaborate directly with pharmacists, technicians, and contact center representatives to quickly resolve orders.

This includes making outbound calls to providers, patients, and payers.

There is currently no expectation for handling inbound phone calls.

Job Profile Summary

Delivers specific delegated Eligibility tasks assigned by a supervisor.

Implements, updates, and maintains automated, direct connect and/or manual eligibility data.

May handle National Accounts or more complex accounts.

Reconciles accounts for non-standard requests.

May provide technical support for the electronic procession of eligibility.

Ensures customer data is installed accurately and timely.

Analyzes formats that are customized directly by the client.

May work directly with Systems to design formats.

Provides recommendations to decrease errors.

Thorough technical knowledge of manual and automated eligibility.

Completes day-to-day Eligibility tasks without immediate supervision, but has ready access to advice from more experienced team members.

Tasks involve a degree of forward planning and anticipation of needs/issues.

Resolves non-routine issues escalated from more junior team members.

Job Description

Express Scriptsand AccredoSpecialty Pharmacyarenow part of Cigna.

Together, we have got big plans.

We want to change health care to make it more affordable, more personalized, and more focused on helping the whole person to achieve better health outcomes.

And that's only the beginning.

Read on to learn more about working with us.

As an Eligibility Representative, Patient Access, Accredo on the WeCARE team,you'll be part of a dedicatedteam whichhelps our specialty pharmacy patients coordinate their medication needs and pharmacy insurance coverage for complex medical conditions such as HIV, rheumatoid arthritis, and more.

This role is on the front lines with patients anddoctorsoffices, responding to phone inquiries and addressing each with care, detail, and most importantly, empathy.

Here's a little more on how you'll make a difference:


* Help patients get the medication they need.Use the knowl...